THE FUNCTIONAL-ANATOMY OF THE URETHRA - ROLE OF THE PUBOURETHRAL LIGAMENTS

OBJECTIVE: This clinical study examines and defines the functional ana tomy of the urethra as it relates to the Valsalva and Kegel maneuvers and to urethral stability. STUDY DESIGN: Dissection of embalmed cadave rs end examination of 60 patients were performed to study adjunct stru ctures in urethral stability. Provocative maneuvers (Valsalva and Kege l) were used in all 60 patients. Urethral prolapse was graded with use of the International Continence Society classification. RESULTS: Cada veric dissection confirmed the structural anatomy of the pubourethral muscles and ligaments. Physical examination in 30 patients revealed a lack of urethral stability in all patients with stress urinary inconti nence. In 30 patients acting as normal controls, no urinary incontinen ce was present, and all maintained urethral stability with provocation . The urethrovesical junction was mobile in all patients in performing a Valsalva maneuver. CONCLUSION: Intact pubourethral ligamentous and muscular attachments aid in stabilizing the urethra to its normal anat omic position. This helps maintain continence.